Radial head subluxation, commonly known as nursemaid's elbow, is a frequent upper extremity injury in young children and typically presents with refusal to use the affected arm without focal distal motor dysfunction. We report an atypical presentation in a previously healthy two-year-and-10-month-old girl who was brought to the emergency department after an unwitnessed event with no clearly identified mechanism of trauma. She held her right elbow flexed against her chest in a posture suggestive of radial head subluxation, and additionally refused to let go of her wrist and demonstrated a wrist-drop posture, absence of active finger movement, mild wrist edema, and tenderness predominantly over the wrist. An initial reduction using a hyperpronation maneuver produced no palpable or audible click and no clinical improvement. Because of the atypical distal findings, further manipulation was deferred, and radiographs of the affected extremity were obtained, showing no acute fracture or dislocation. A second hyperpronation reduction was subsequently performed, during which a distinct palpable and audible click was appreciated. Immediately afterward, active wrist extension returned and the wrist-drop posture resolved. The patient reached for and successfully held an object, and within approximately two minutes demonstrated full spontaneous movement of the affected upper extremity without residual tenderness, edema, or apparent motor deficit. She was observed for 20-30 minutes and subsequently discharged home. This case highlights an unusual neurologic-appearing presentation of radial head subluxation. The rapid resolution following successful reduction suggests a close association between the subluxation and transient distal dysfunction; however, pain-mediated pseudoparalysis and transient radial motor nerve dysfunction cannot be reliably distinguished in a young child.

Post-stroke shoulder-hand syndrome and hand edema can complicate inpatient rehabilitation and may reflect interactions between antioxidant, nutritional, inflammatory, and neuro-musculoskeletal factors. This single-center retrospective cohort study included 453 adults admitted for inpatient rehabilitation within 60 days after a first-ever unilateral ischemic or hemorrhagic stroke between 1 January 2018 and 31 December 2025. The primary exposure was the number of abnormal antioxidant-, nutritional-, and inflammation-related biomarkers, defined as serum zinc <70 µg/dL, albumin <3.5 g/dL, C-reactive protein ≥1.0 mg/dL, and neutrophil-to-lymphocyte ratio ≥3.0. The primary outcome was shoulder-hand syndrome or clinically significant hand edema during inpatient rehabilitation. In multivariable logistic regression with robust standard errors, each 1-unit increase in the number of abnormal biomarkers was associated with higher odds of the primary composite outcome (odds ratio, 1.43; 95% confidence interval, 1.15-1.77; p = 0.001). Directionally consistent associations were observed for shoulder-hand syndrome, clinically significant hand edema, Fugl-Meyer upper-extremity score at discharge, and poor upper-limb function at discharge. In a temporal sensitivity analysis excluding the 28 patients with the primary outcome already documented at PM&R admission (N = 425), biomarker profiling preceded the documented outcome in all 98 subsequent event cases, and the association remained (odds ratio, 1.42; 95% confidence interval, 1.12-1.79; p = 0.004). These findings indicate that a higher burden of abnormal antioxidant-, nutritional-, and inflammation-related biomarkers was associated with a clinical profile characterized by upper-limb complications and less favorable short-term motor function; the burden measure is not validated for prediction.

Eosinophilic cellulitis, also known as Wells syndrome, is a rare inflammatory dermatosis that may clinically mimic bacterial cellulitis and contribute to diagnostic delay. We report the case of a 72-year-old woman with a history of systemic lupus erythematosus and other autoimmune comorbidities who initially presented with bilateral lower extremity erythema and received antibiotic therapy for presumed cellulitis, with transient improvement. Three days after completing treatment, she developed recurrent pruritic erythematous plaques involving both upper and lower extremities, accompanied by edema and pain, without significant improvement following antihistamine therapy. Laboratory studies revealed peripheral eosinophilia (absolute eosinophil count 1.07 × 10[3]/µL) and elevated erythrocyte sedimentation rate. Punch biopsy showed eosinophil-rich interstitial and perivascular inflammatory infiltrates consistent with eosinophilic cellulitis, and the patient subsequently improved with systemic corticosteroid therapy. This case highlights the importance of considering Wells syndrome in patients with recurrent cellulitis-like eruptions, particularly when response to antibiotic therapy is incomplete or transient. Early biopsy and clinicopathologic correlation remain essential for accurate diagnosis and timely management.

Acute ischemic lesions are occasionally detected in patients with intracerebral hemorrhage, but they are usually remote from the hematoma. Acute infarction adjacent to hypertensive putaminal hemorrhage is extremely rare. We report a 52-year-old man with untreated hypertension who presented with right upper extremity weakness, gait unsteadiness, and left temporal headache. Computed tomography showed a left putaminal hematoma with surrounding edema and a subtle adjacent hypoattenuating area. Magnetic resonance imaging demonstrated an acute infarction adjacent to the superomedial aspect of the hematoma, extending toward the left corona radiata within the lenticulostriate artery territory. No major arterial stenosis, vascular malformation, cardioembolic source, coagulopathy, or vasculitis was identified. His symptoms gradually improved with antihypertensive therapy. The mechanism remains uncertain, but hematoma-related local compression or hypoperfusion and concomitant hypertensive small vessel pathology may have contributed to the adjacent infarction. This case highlights the importance of differentiating hematoma-associated adjacent infarction from hemorrhagic transformation of ischemic stroke.

Thoracic central venous obstruction (TCVO) can cause facial and upper extremity edema and it is often associated with malignancies. We herein report a rare case of cervical esophageal squamous cell carcinoma complicated by TCVO type 2 during chemoradiotherapy. Approximately 1 week after starting 5-fluorouracil plus cisplatin with radiotherapy, the patient developed acute painful swelling of the left arm. Contrast-enhanced computed tomography revealed thrombosis of the left internal jugular vein with extrinsic compression of the ipsilateral subclavian vein by a cervical tumor. Symptoms improved after anticoagulation therapy while chemoradiotherapy was continued, although the improvement was likely multifactorial.

Complex regional pain syndrome (CRPS) is a debilitating pain disorder that most commonly develops following fractures, surgery, peripheral nerve injury, or other trauma to an extremity. Although substantial progress has been made in understanding its underlying neurobiology, CRPS remains difficult to diagnose and treat because of its heterogeneous clinical presentation and the absence of a single universally effective therapy. Patients often experience pain disproportionate to the inciting event, accompanied by sensory disturbances, autonomic dysfunction, edema, motor impairment, and trophic changes that collectively impair limb function and quality of life. For hand and upper-extremity surgeons, delayed recognition may result in prolonged disability, while premature diagnosis may obscure alternative conditions requiring surgical intervention. This review synthesizes 22 full-text publications identified through a staged, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-style screening pathway of 1,471 PubMed records. Current literature consistently supports a multidisciplinary, function-centered treatment strategy. Clinical diagnosis using the Budapest Criteria remains the foundation of evaluation, while imaging and ancillary investigations are primarily used to exclude competing diagnoses. Early patient education, desensitization, edema management, and supervised rehabilitation represent the cornerstone of treatment. Pharmacologic therapies, including corticosteroids, bisphosphonates, neuropathic pain medications, and selected intravenous therapies, may facilitate functional recovery in carefully selected patients, although the certainty of evidence varies considerably. Sympathetic blockade, ketamine infusion, spinal cord stimulation, and dorsal root ganglion stimulation are best considered adjunctive therapies for patients with persistent symptoms despite comprehensive conservative management. Current evidence favors a staged, multidisciplinary approach in which restoration of limb function serves as the primary therapeutic objective. Rehabilitation should begin as early as possible, while medications and interventional procedures should be used to facilitate participation in therapy rather than replace it. For hand and upper-extremity surgeons, prompt recognition, exclusion of alternative diagnoses, avoidance of unnecessarily prolonged immobilization, and coordinated multidisciplinary care remain the most important modifiable factors influencing patient outcomes.

Postoperative brachial plexopathy is a rare but recognized complication of cervical spine surgery, typically resulting from intraoperative traction, positioning, or compression of the brachial plexus. We present the case of a man in his 50s with poorly controlled diabetes who developed acute, severe upper-extremity pain, weakness, and numbness two days after a multilevel anterior cervical discectomy and fusion for cervical stenosis. Examination revealed C5-C6 deficits, and electromyography demonstrated active denervation in multiple muscles innervated by these roots. Magnetic resonance imaging (MRI) of the brachial plexus showed mild edema, while shoulder imaging revealed extensive rotator-cuff pathology. This case underscores the diagnostic challenge of distinguishing postoperative brachial plexopathy from simultaneous musculoskeletal disease and highlights the importance of early electrodiagnostic testing, careful imaging assessment, and timely management in high-risk patients.